Successful treatment of ceftazidime-resistant Klebsiella pneumoniae ventriculitis with intravenous meropenem and intraventricular polymyxin B: case report and review

Clin Infect Dis. 1999 May;28(5):1134-8. doi: 10.1086/514754.

Abstract

Increasing prevalence of multidrug-resistant gram-negative organisms has led to a rise in clinically significant infections with these organisms and an increasing therapeutic dilemma. We present a case of a neurosurgical patient who developed ventriculoperitoneal shunt-associated ventriculitis due to ceftazidime-resistant Klebsiella pneumoniae susceptible to cefepime, imipenem, meropenem, and polymyxin B only. Successful management was accomplished by removal of the shunt and therapy with systemic meropenem and intraventricular polymyxin B. Rapid cerebrospinal fluid (CSF) sterilization occurred, with CSF bactericidal titers of 1:32 to 1:128. Polymyxin B should be considered as adjunctive therapy for life-threatening multidrug-resistant gram-negative infections. Prior literature on use of intrathecal polymyxin B in therapy for meningitis supports its potential efficacy.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Ceftazidime*
  • Cerebrospinal Fluid / microbiology
  • Cross Infection / drug therapy
  • Cross Infection / microbiology
  • Drug Resistance, Microbial
  • Female
  • Humans
  • Injections, Intravenous
  • Injections, Intraventricular
  • Klebsiella Infections / drug therapy*
  • Klebsiella Infections / microbiology
  • Klebsiella pneumoniae / genetics
  • Klebsiella pneumoniae / isolation & purification
  • Meropenem
  • Middle Aged
  • Polymyxin B / therapeutic use*
  • Thienamycins / therapeutic use*

Substances

  • Anti-Bacterial Agents
  • Thienamycins
  • Ceftazidime
  • Meropenem
  • Polymyxin B